Ultrasound screening for abdominal aortic aneurysm in primary care. / Utilidad de la ecografía en el cribado del aneurisma de aorta abdominal en atención primaria.

INTRODUCTION: Abdominal aortic aneurysm (AAA) constitutes a pathology with high mortality. There is currently no screening program implemented in primary care in Spain. OBJECTIVES: To evaluate the usefulness of ultrasound in the detection of AAA in the at-risk population in primary care. Secondarily, to identify subjects whose vascular risk (VR) should be reclassified and to determine whether AAA is associated with the presence of carotid plaque and other risk factors. MATERIAL AND METHODS: Cross-sectional, descriptive, multicenter, national, descriptive study in primary care. SUBJECTS: A consecutive selection of hypertensive males aged between 65 and 75 who are either smokers or former smokers, or individuals over the age of 50 of both sexes with a family history of AAA. MEASUREMENTS: Diameter of abdominal aorta and iliac arteries; detection of abdominal aortic and carotid atherosclerotic plaque. VR was calculated at the beginning and after testing (SCORE). RESULTS: One hundred and fifty patients were analyzed (age: 68.3±5 years; 89.3% male). Baseline RV was high/very high in 55.3%. AAA was detected in 12 patients (8%; 95% CI: 4-12); aortic ectasia in 13 (8.7%); abdominal aortic plaque in 44% and carotid plaque in 62% of the participants. VR was reclassified in 50% of subjects. The detection of AAA or ectasia was associated with the presence of carotid plaque, current smoking and lipoprotein(a), p<0.01. CONCLUSIONS: The prevalence of AAA in patients with VR is high. Ultrasound in primary care allows detection of AAA and subclinical atherosclerosis and consequently reclassification of the VR, demonstrating its utility in screening for AAA in the at-risk population.

Translation and adaptation to Spanish of Aberdeen varicose veins questionnaire.

OBJECTIVE: The purpose of the study is to translate the Aberdeen Varicose Vein Questionnaire (AVVQ) into Spanish and evaluate the feasibility and reliability of the Spanish-translated AVVQ in patients with chronic venous disease. METHODS: Reliability was assessed by test and retest of the Spanish translated AVVQ in a sample of 77 patients. The questionnaires were answered within a 2-week interval. RESULTS: There was a 100% test and retest response. The AVVQ showed 6.5% of missing responses. Cronbach's alpha was 0.71 indicating an adequate level of internal consistency. Spearman's rho showed a significant strong association between test and retest scores (rho = 0.84, p < 0.0001). CONCLUSIONS: The Spanish-translated AVVQ is a reliable tool in our daily clinical practice in order to measure the impact of venous disease in the quality of life.

Treatment of Thoracic Outlet Syndrome Complications Assisted with a Cerebral Embolism Protection Device.

We report a case of a stroke and upper limb ischemia in a 27-year-old female secondary to a right cervical rib and retrograde thromboembolization. Follow-up showed complete patency of the vessels after thrombectomy and internal carotid artery stenting followed by transbrachial embolectomy performed with a cerebral protection device. The cervical rib was surgically removed to prevent additional events.

Reparación de aneurisma complejo de arteria renal izquierda: nefrectomía laparoscópica, reconstrucción en banco y autotrasplante heterotópico / Repair of complex left renal artery aneurysm: laparoscopic nephrectomy, ex vivo reconstruction and heterotopic autotransplantation

Los aneurismas de la arteria renal son entidades clínicas poco frecuentes. Si bien la mayoría de casos son asintomáticos y se detectan incidentalmente, su rotura se asocia a elevadas tasas de mortalidad y de pérdida del riñón, lo que afecta a los supervivientes. Aunque la mayoría de estos aneurismas pueden tratarse mediante técnicas de reparación endovascular o in situ, esto puede no ser posible en pacientes con aneurismas complejos, como aquellos localizados en la bifurcación arterial. Presentamos el caso de un aneurisma renal complejo tratado satisfactoriamente mediante nefrectomía laparoscópica, reconstrucción vascular en banco y autotrasplante heterotópico.(AU)

renal artery aneurysms are rare clinical entities. While most cases are asymptomatic and detected incidentally, rupture is associated with high mortality rates and loss of the aff ected kidney in survivors. although most of these aneurysms can be treated by endovascular or in situ repair techniques, this may not be possible in patients with complex aneurysms, such as those located at the arterial bifurcation. We present a case of complex renal aneurysm successfully treated by laparoscopic nephrectomy, ex vivo vascular reconstruction, and heterotopic autotransplantation.(AU)

Unilateral Proptosis (Exophthalmos) Caused by Axillary-Subclavian Venous Thrombosis in a Patient with Upper Extremity Arteriovenous Dialysis Fistula.

Arterialization of orbital veins is most often due to dural arteriovenous malformations of the cavernous sinus area. We report an unusual case of unilateral proptosis (exophthalmos) caused by arterialized retrograde venous flow in the external jugular vein and cavernous sinus in a patient with an upper extremity hemodialysis fistula and ipsilateral acute central venous thrombosis. The patient's symptoms improved after surgical closure of the hemodialysis fistula.

Complicaciones trombóticas arteriales en pacientes COVID-19 / Arterial thrombotic complications in COVID-19 patients

Objetivos: presentar nuestra experiencia en relación a la incidencia, pronóstico y tratamiento de pacientes COVID-19 hospitalizados con trombosis arterial periférica en un hospital terciario de Madrid. Material y métodos: se diseñó un estudio observacional de cohorte de pacientes COVID-19 confirmados (PCR-positiva) en el Hospital Universitario 12 de Octubre. Analizamos todas las trombosis arteriales periféricas sintomáticas diagnosticadas y tratadas durante los meses de marzo y abril de 2020, correspondientes a la primera ola de la pandemia. Debido a la ausencia de camas en la unidad de cuidados intensivos (UCI) y reanimación posoperatoria, toda la cirugía electiva programada fue cancelada durante este periodo y solo se realizaron cirugías urgentes. Resultados: desde el 1 de marzo al 30 de abril ingresaron en nuestro hospital 2943 pacientes con COVID-19 y de estos 261 en la UCI. Durante este periodo se realizaron 154 operaciones urgentes a pacientes COVID-19 en nuestro hospital. Catorce pacientes COVID-19 fueron diagnosticados con trombosis arterial periférica sintomática. La edad promedio fue de 74 años (rango, 50-92) y estos eventos fueron más comunes en hombres que en mujeres (12:2). De estos 14 pacientes, solo siete fueron sometidos a cirugía vascular por isquemia aguda en las extremidades. Esto representó el 4,5 % de todas las operaciones urgentes realizadas en nuestro hospital. La mortalidad posoperatoria fue 4 de 7 pacientes por retrombosis a pesar de la anticoagulación. Entre los pacientes no operados, 2 presentaban trombo aórtico flotante y evolucionaron satisfactoriamente con anticoagulación, mientras que los otros 5 pacientes debido a las malas condiciones clínicas fueron manejados con medidas paliativas hasta su fallecimiento. Ningún parámetro analítico fue predictivo de trombosis arterial. No se registraron hemorragias en esta serie...(AU)

Objectives: to describe our experience of incidence, prognosis and management of hospitalized COVID-19 patients with peripheral arterial thrombosis in a major teaching hospital in Madrid (Spain). Material and methods: we designed an observational cohort study of confirmed (PCR-test) COVID-19 patients at the Hospital Universitario 12 de Octubre. We analyzed all symptomatic peripheral arterial thrombosis diagnosed and treated during March and April 2020, which corresponds to the first wave of the pandemic. All elective scheduled surgery was canceled during this period due to absence of postoperative intensive care unit (ICU) or resuscitation beds and only urgent surgeries were performed. Results: from March 1 to April 30, 2,943 COVID-19 patients were admitted in our hospital and 261 patients in the intensive care unit (ICU). During this period, 154 urgent operations were performed on COVID-19 patients in our hospital. Fourteen COVID-19 patients were diagnosed with symptomatic peripheral arterial thrombosis. The average age was 74 (range, 50-92) and these events were more common in men than in women (12:2). Out of these 14 patients, only 7 underwent vascular surgery by acute limb ischemia. This represented 4.5 % of all urgent operations performed in our hospital. Postoperative mortality was 4 of 7 patients due to re-thrombosis despite anticoagulation. Among the non-operated patients, 2 had floating aortic thrombus and evolved satisfactorily with anticoagulation, while the other 5 patients were managed by palliatives measures due to the poor clinical conditions until they died. No analytical parameter was predictive of arterial thrombosis. No bleedings were recorded in this series...(AU)

Controversias en el síndrome de congestión pélvica. Una perspectiva hemodinámica / Controversies in pelvic congestion syndrome. A hemodynamic perspective

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Síndrome de congestión pélvica: revisión actualizada de la literatura / Pelvic congestion syndrome: updated literature review

El síndrome de congestión pélvica (SCP) es una causa frecuente, aunque poco conocida, de dolor pélvico crónico en mujeres premenopáusicas. Aunque su etiología no está del todo clara, en general se acepta la incompetencia valvular como causa del SCP primario, mientras los síndromes compresivos llevan al SCP secundario. El diagnóstico de este síndrome se realiza después de excluir otras causas de dolor pélvico crónico y se basa en una combinación de síntomas clínicos característicos (dolor crónico, continuo o sordo, dispareunia, dismenorrea...) y en la documentación de dilatación o incompetencia de las venas pélvicas mediante pruebas de imagen. La terapia endovascular (escleroterapia, embolización o stent) de las venas incompetentes con reflujo o venas estenóticas constituye el estándar de tratamiento. El objetivo del presente trabajo es realizar una revisión actualizada de la literatura con el propósito de ayudar a mejorar el conocimiento de esta patología

Pelvic congestion syndrome (PCS) is a common, but little-known, cause of chronic pelvic pain in premenopausal women. Although its etiology is not entirely clear, valvular incompetence is generally accepted as the cause of primary PCS, while compressive syndromes lead to secondary PCS. The diagnosis of this syndrome is made after excluding other causes of chronic pelvic pain, and is based on a combination of characteristic clinical symptoms (chronic pain, continuous or dull, dyspareunia, and dysmenorrhea) and documentation of dilation or incompetence of pelvic veins by imaging tests. Endovascular therapy (sclerotherapy, embolization or stenting) of incompetent and reflux veins or stenotic veins, is today the standard of treatment. The objective of this work is to carry out an updated revision of the literature with the purpose of helping to improve the knowledge of this pathology

COVID-19-Related Aortic Thrombosis: A Report of Four Cases.

COVID-19 may predispose patients to an increased risk of thrombotic complications through various pathophysiological mechanisms. Most of the reports on a high incidence of thrombotic complications are in relation to deep vein thrombosis and pulmonary embolism, while the evidence about arterial thrombosis in patients with COVID-19 is limited. We describe 4 cases of aortic thrombosis and associated ischemic complications in patients with severe SARS-CoV-2 infection.

Tratamiento endovascular de la aortitis infecciosa: una opción segura y eficaz con antibioterapia mantenida / Endovascular treatment of infectious aortitis: a safe and effective option with maintained antibiotic treatment

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Sistema de aspiración Indigo® de Penumbra / Penumbra Indigo System® aspiration

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Tronco común de arterias renales como variante anatómica muy poco frecuente: a propósito de un caso de embolismo renal / Common trunk of renal arteries as a very rare anatomic variant: about a case of renal embolism

Las variaciones anatómicas en la vascularización arterial renal son altamente prevalentes y su conocimiento es de especial interés clínico. Nuestro objetivo es describir una variante anatómica de las arterias renales poco conocida en la literatura actual

The anatomical variations in renal arterial vascularization are highly prevalent and their knowledge is of special clinical interest. Our aim is to describe an anatomical variant of the renal arteries little known in current literatura

El Dr. Google y las falsas noticias / Dr. Google and fake news

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Un consenso útil para la práctica clínica / No disponible

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Lower Expression of Genes Involved in Protection against Oxidative Stress in Symptomatic Carotid Atherosclerosis.

BACKGROUND: Oxidative stress is increased in atherosclerosis, manifested both in blood and tissue (atherosclerotic plaque). We aim at describing the expression of a number of genes related to oxidative stress response in carotid atherosclerotic plaques and their relation to symptomatic state. METHODS: We have studied the messenger RNA expression levels for genes related to oxidative stress in a population of 44 patients undergoing carotid endarterectomy, according to the presence (24 patients) or absence (20 patients) of symptoms. Samples were homogenized, RNA was extracted, and gene expression was measured by quantitative reverse transcription polymerase chain reaction arrays. RESULTS: Data showed a decrease in expression of oxidative stress protective genes in symptomatic patients and increased expression of pro-oxidant genes. Asymptomatic patients maintain higher levels of expression of protective genes in the tissue. CONCLUSIONS: This study establishes a close relationship between symptoms and levels of expression of genes that protect against oxidative stress. We propose the existence of a mechanism that silences these genes, causing a more severe atherosclerotic disease state.